Policy brief: how to expand APRNsí scope of practice

The Robert Wood Johnson Foundation has issued a policy brief about ways to clear barriers blocking APRNs from broadening their scope of practice to meet the rising demand for healthcare services.

Such barriers may be legal (state laws and regulations that prohibit APRNs from practicing to the full extent of their training and education, Medicare and Medicaid reimbursement restrictions that effectively do the same); institutional (hospital policies that are more restrictive than state laws and regulations, barring APRNs from admitting patients or performing certain procedures); and cultural (resistance by some hospitals and other healthcare institutions to team-based, interprofessional care).

"The majority of states place significant and unnecessary restrictions on APRNs, causing delays in treatment and making it difficult for APRNs to provide care in rural areas, where physicians are often scarce," Maryjoan Ladden, RN, PhD, FAAN, senior program officer for RWJF and executive editor of Charting Nursingís Future, said in a news release.

"Between healthcare reform and the aging patient population, we need all hands on deck."

The brief highlights three models for better leveraging the skills, knowledge, and experience of APRNs:

• The U.S. Department of Veterans Affairs employs more than 5,000 APRNs, providing primary, specialty, acute, ambulatory, tele-health and home healthcare services. Relying on the constitutional doctrine of federal supremacy, the VA plans to allow APRNs who meet certain criteria to practice to the full extent of their education and training without direct supervision from physicians, even in jurisdictions with more restrictive regulations.

• The University of Pennsylvania Health System has pioneered the Transitional Care Model, an approach that relies on APRN specialists to design and implement comprehensive plans for follow-up care for discharged hospital patients. An initial clinical trial of the approach produced strong results, providing improved health outcomes at significantly lower cost.

• The Duke University Health Systemís Department of Cardiovascular Medicine has adopted an interprofessional team-based approach to increase access to care and improve patient satisfaction. Under the new model, nurses, physicians and physician assistants all are able to work to the top of their competency and licensure.